About Me

My mother was murdered by what I call corporate and political homicide i.e. FOR PROFIT! she died from a rare phenotype of CJD i.e. the Heidenhain Variant of Creutzfeldt Jakob Disease i.e. sporadic, simply meaning from unknown route and source. I have simply been trying to validate her death DOD 12/14/97 with the truth. There is a route, and there is a source. There are many here in the USA. WE must make CJD and all human TSE, of all age groups 'reportable' Nationally and Internationally, with a written CJD questionnaire asking real questions pertaining to route and source of this agent. Friendly fire has the potential to play a huge role in the continued transmission of this agent via the medical, dental, and surgical arena. We must not flounder any longer. ...TSS

Thursday, February 11, 2010

CBS) They call it the "Danish Experiment" - a source of pride for the country's 17,000 farmers. CBS Evening News Anchor Katie Couric reports how unlike industrial farms in the U.S., which use antibiotics to promote growth and prevent disease, farmers in Denmark use antibiotics sparingly, only when animals are sick.

The experiment to stop widespread use of antibiotics was launched 12 years ago, when European studies showed a link between animals who were consuming antibiotic feed everyday and people developing antibiotic resistant infections from handling or eating that meat.

"We don't want to use more medicine than needed, and a lot of the medicine that is given is not needed," said Soren Helmer. Helmer is a second-generation pig farmer whose sows produce more than 30,000 pigs a year. When the ban started, he and his father thought the industry would suffer.

"We thought we could not produce pigs as efficient as we did before," Helmer said. "But that was proven wrong."

Since the ban, the Danish pork industry has grown by 43 percent - making it one of the top exporters of pork in the world. All of Europe followed suit in 2006. But the American Pork Industry doesn't want to.

"What we've seen in Denmark and other countries is that they actually have had some increases in cost of what it takes to produce a pig," said Liz Wagstrom, a veterinarian with the National Pork Board.

"So it's not that unqualified a success. If we did the same thing in the United States, we would likely see small producers pushed out of business, we'd have more sick and dying pigs, and none of that would result in a benefit to the U.S. consumer."

Without growth-promoting antibiotics, it only costs $5 more for every 100 pounds of pork brought to market in this country.

Animal Antibiotics a Threat?

That's a small price for public health, says Dr. Ellen Silbergeld, who has been studying the antibiotic resistance link between livestock and people for the past decade.

"I think the Danish and European experience indicate that there will be real and measurable public health benefits," she said. "There'll be improvements in food safety and actually in the prevalence of drug resistant infections in people."

Pew Campaign on Human Health and Industrial Farming

According to one study, when different countries introduced certain antibiotics on farms, a surge occurred in people contracting antibiotic resistant intestinal infections one to two years later. One infection, Campylobacter, increased 20 percent in Denmark and 70 percent in Spain.

After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.

Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.

"It's not going to be a time bomb that goes off like this," said Dr. Frank Aarestrup, of the Danish Food Institute at the University of Denmark. "It's something that's slowly getting more and more complicated, more difficult for us to actually treat infections.

"What most bothers you about the way industrial farmers in this country currently operate," Couric asked.

"We use too many antibiotics, we use too many growth promotants," McDonnell replied. "The singular focus is to create cheap meat. That's not always the best thing for the health of the Americans who buy it."

"We think with some subtle changes - giving them more space, feeding them a good diet, and not stressing them out by growing them too quickly - you don't even need to use antibiotics," McDonnell added.

McDonnell helps farmers like Duane Koch kick the habit.

"How long have you been raising turkeys, Duane, without using antibiotics," Couric asked.

"Yeah," Koch said. "Because really, from using the antibiotics so long, a lot of them didn't work well any way anymore."

Today his 18 poultry farms scattered throughout Pennsylvania are more profitable than when he used antibiotics.

Koch says it costs very little to convert a farm to antibiotic-free. And it doesn't cost consumers much more either. People buying antibiotic free turkey thigh meat will spend around $1.40 versus $1.20 for conventionally raised birds.

Koch says higher-quality feed and improving living conditions, his birds are naturally healthier.

Couric asked, "What's the importance of giving them more space?"

"That's just our natural growth promotants," he said. "By giving them more space, we can get weights that are really close to what they're getting, you know, with the growth promotants."

Because farmers are raising livestock successfully without growth-promoting antibiotics - from Lebanon, Pennsylvania to outside Copenhagen - public health officials in this country say this is an idea whose time has come.

"We have identified here that we're talking about a public health issue, that the overuse of antibiotics on farms does pose a risk to human health," said Joshua Sharfstein of the FDA.

The FDA has for the first time come out against using certain antibiotics to promote growth in livestock.

And pending legislation in Congress would ban some types of antibiotics used to treat humans from being administered to healthy farm animals.

Thank you very much on that show of yours about antibiotics in meat, the over-use-of, and resistance there from, to humans and animals. Nice Job! The public is just oblivious to what is going on with the meat they eat. I thought the Danish study was remarkable, and proves what can be done, if an industry wants to do something. sadly, here in the USA, all the industry cares about is their bottom dollar. I have been most concerned about hormones, antibiotics, TSE aka mad cow disease, and other pathogens in meat for some time. I lost my mother to the Heidenhain Variant of Creutzfeldt Jakob Disease, considering North America is home to c-BSE, h-BSE, and the l-BSE in cattle, who is it to say that it should look exactly like the UK c-BSE ??? THEN, my last neck surgery, I believe my neurosurgeon did use a special bone grinder and a few extra precaustion, due to my Mother having died from hvCJD, and they damn near kill me with MRSA. Looking into to that, I was amazed at the amount of antibiotics and hormones that go into cattle due to the fact they are to sick to slaughter. 8 weeks vancomycin straight to the heart via long pic line made a believer in me. now I know some how I was infected probably via the operating arena, there were 7 other's the same week from the same surgcial unit, I was told later (this was in 2002), but we have become immune to these medicines due to over use, not only in humans but animals for human consumption as well. at any given tuesday you can find something like this ;

On April 23 and May 4,2009, the Minnesota Department of Agriculture conducted an investigation of your dairy operation located at 26162 240th Street, Paynesville, Minnesota. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that were found during the investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.

The investigation found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.

Specifically, the investigation revealed that on or about September 16, 2008, you sold a dairy cow identified with your farm ear tag #(b)(4)for slaughter as food. On or about September 17, 2008, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of neomycin at 31.05 parts per million (ppm) in kidney tissue. FDA has established a tolerance of 7.2 ppm neomycin residue in kidney tissue as codified in Title 21, Code of Federal Regulations, Section 556.430(b)(1), 21 C.F.R. 556.430(b)(1). The presence of this drug in kidney tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).

The investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).

The investigation also found that you adulterated the new animal drugs neomycin sulfate, sulfadimethoxine oral solution, oxytetracycline injection, oxytetracycline hydrochloride injection, ceftiofur hydrochloride, ceftiofur crystalline free acid, ceftiofur sodium, penicillin G procaine aqueous suspension, florfenicol, tetracycline hydrochloride soluble powder, and tylosin. Specifically, the investigation revealed that you did not use these drugs as directed by their approved labeling. Use of these drugs contrary to their approved labeling is an extralabel use. See 21 C.F.R. 530.3(a).

The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. §§ 360b(a)(4) and (5), and 21 C.F.R. 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/ client/patient relationship.

The investigation found that you administered neomycin sulfate to lactating dairy cows contrary to the approved indication of use. Neomycin sulfate is not approved for the treatment and control of Salmonella infections. Your extralabel use of neomycin sulfate was not in compliance with 21 C.F.R. 530, and your extralabel use of neomycin sulfate resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d).

The investigation also found that you administered the following new animal drugs contrary to the conditions of use set forth in their approved labeling, and you did so without the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a):

1. Neomycin sulfate (b)(4) - You administered neomycin sulfate to a lactating dairy cow without following the approved indication of use. Neomycin Sulfate (Neomycin Liquid) is not approved for the treatment and control of Salmonella infections.

2. Sulfadhnethoxine oral solution (b)(4) - You administered sulfadimethoxine oral solution to lactating dairy cows without following the approved route of administration, indications for use, and animal class. Sulfadimethoxine oral solution is not approved for intravenous injection, not approved to treat peritonitis, and not approved for use in lactating dairy cows. Furthermore, sulfonamide drugs, which include sulfadimethoxine, are prohibited for extralabel use in lactating dairy cows by 21 C.F.R. 530.41(a)(9).

3. Oxytetracycline injection (b)(4) - You administered oxytetracycline injection to lactating dairy cows without following the approved dose per injection site. Oxytetracycline injection is not approved for use at more than 10 mL per injection site.

4. Oxytetracycline hydrochloride injection (b)(4) - You administered oxytetracycline hydrochloride injection to lactating dairy cows without following the approved animal class and indications for use. Oxytetracycline hydrochloride injection is not approved for use in lactating dairy cattle, or to treat peritonitis.

5. Ceftiofur hydrochloride (b)(4) - You administered ceftiofur hydrochloride to lactating dairy cows without following the approved indications for use. Ceftiofur hydrochloride is not indicated for treating watery mastitis in cattle, or for post-surgical use.

7. Ceftiofur sodium (b)(4) - You administered ceftiofur sodium to lactating dairy cows without following the approved indications for use. Ceftiofur sodium is not indicated for treating watery mastitis or metritis in cattle, nor is it approved for post-surgical use.

8. Penicillin G procaine (b)(4) - You administered penicillin G procaine aqueous suspension to lactating dairy cows without following the approved indications for use, dosage amount, or dosage amount per injection site. Penicillin G procaine aqueous suspension is not indicated for treating mastitis in cattle, not approved at a dose more than 1 mLI100 pounds of body weight, and not approved for use at the rate of more than 10 mL per injection site.

9. Florfenicol (b)(4) - You administered florfenicol to lactating dairy cows without following the approved animal class. Florfenicol is not approved for use in female dairy cattle 20 months of age or older.

10.Tetracycline hydrochloride soluble powder (b)(4) - You administered tetracycline hydrochloride soluble powder to lactating dairy cows without following the approved animal class and indications for use. Tetracycline hydrochloride soluble powder is not approved for treating dairy cows or for treatment of uterine infections.

11. Tylosin (b)(4) - You administered tylosin to dairy calves without following the approved route of administration and indications for use.Tylosin is not approved for oral administration, nor is the drug approved for preventing scours (bacterial enteritis) in dairy calves. Furthermore, the extralabel use of approved new animal or human drugs in or on an animal feed (milk) is prohibited by 21 C.F.R. 530.11(b).

Because your use of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. 530, you caused the drugs to be unsafe under section 512(a) of the Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 50 1(a)(5) of the Act, 21 U.S.C. § 351(a)(5).

In addition, you adulterated animal feed (milk) within the meaning of section 501 (a)(6) of the Act, 21 U.S.C. § 351 (a)(6). You administered tylosin to dairy calves to prevent Escherichia coli (E. colI) scours by mixing the drug in milk. This caused the animal feed (milk) to which the drug was added to be unsafe within the meaning of section 512(a)(2) of the Act, 21 U.S.C. § 360b(a)(2), and adulterated under section 501(a)(6) of the Act, 21 U.S.C. § 351(a)(6).

The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute are in compliance with the law.

You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.

You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within 15 working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and to prevent their recurrence. If corrective action cannot be completed within 15 working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.

Your written response should be sent to Dr. Brian D. Garthwaite, Compliance Officer, U.S. Food and Drug Administration, at the address located on the letterhead. If you have any questions about this letter, please contact Dr. Garthwaite at (612) 758-7132.

It should be noted that humans can become more susceptible to infection with antimicrobial-resistant zoonotic bacteria to which they are exposed. This can happen, when there has been prior use of antimicrobials, resulting in decrease in colonization resistance (dysregulation of intestinal microbiota) and an increased vulnerability to gastrointestinal illness with antimicrobial-resistant food-borne pathogens. This applies to all infections with all micro-organisms listed in this document.

Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.).

We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene.

In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398.

These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.

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Discussion

This study is the first to document MRSA in U.S. swine and swine workers, and to our knowledge, the first to report the presence of ST398 (also reported as non-typeable MRSA, NT-MRSA) [15] in the U.S. Like previous studies in Canada, Denmark, and the Netherlands [11], [12], [24], ST398 was found in both animals and humans, suggesting transmission between the two. The prevalence of MRSA colonization among swine and swine workers was high at one farm system that we examined in the Midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. Strain ST398 was the only MRSA identified among the swine and swine workers. This strain has been the predominant strain among swine in the Netherlands and Canada. However, Khanna et al. in Canada recently found both ST398 and ST5/USA100 colonizing the nares of swine and swine workers [12]. This difference may indicate that the epidemiology of MRSA on Canadian swine farms is different than on the affected farm system in Iowa and Illinois. On the other hand, the difference may have resulted from differing sampling methodologies. Khanna et al. sampled a small number of humans and swine on 20 farms whereas we took a larger number of samples from a smaller number of farms in two corporate systems. Furthermore, because we did not type all isolates in this pilot study, additional strain types may be present that we did not detect.

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In summary, we report the first isolation of MRSA from swine and swine workers in the U.S. Although the extent of this problem in the U.S. is currently unknown, our findings may have important implications for the epidemiology of MRSA disease. For example, Van Loo et al. identified MRSA in meat products in the Netherlands [32], suggesting that persons who handle raw pork products might be at risk for acquiring MRSA. Future studies should assess the risk of MRSA disease among swine workers and their contacts, survey retail meat products for MRSA contamination, study larger populations of swine and humans to define the epidemiology of MRSA within swine operations, and assess MRSA carriage rates in other livestock.

Abstract Closely related Staphylococcus aureus strains of ST398, an animal-associated strain, were identified in samples collected from humans in northern Manhattan, New York, NY, USA, and in the Dominican Republic. A large population in northern Manhattan has close ties to the Dominican Republic, suggesting international transmission.

We identified a clone of S. aureus previously associated with outbreaks of infections in animals and in humans who work with animals in 2 unique collections of S. aureus isolates. The first was from a population-based study of S. aureus colonization among residents of northern Manhattan in New York, NY, USA;

The frequency of MRSA ST398 in the Spanish population is unknown. In this study, we present the first three human cases of MRSA ST398 infections admitted to two hospitals in the north-west of Spain.

Forty-four MRSA strains were isolated in 2006 in both hospitals. They were studied by the analysis of restriction fragment length polymorphism (RFLP) of the coagulase gene patterns and pulsed-field gel electrophoresis (PFGE) [3, 4]. Three non-Sma I typeable MRSA strains were identified; the three strains were EagI PFGE typeable. Next, they were analyzed by multilocus sequence typing (MLST) and spa typing [5, 6]. The staphylococcal chromosome cassette (SCC) mec, the accessory gene regulator (agr) types, and the Panton–Valentine leukocidin (PVL)-encoding genes were polymerase chain reaction (PCR)-identified [7–9].

The three strains were resistant to tetracycline. Besides, one isolate was resistant to levofloxacin, tobramycin, and erythromycin, and another isolate was resistant to levofloxacin and clindamycin, and susceptible to erythromycin; this rare phenotype has already been described [2]. The three MRSA isolates were identical by RFLP. By EagI PFGE, they were closely related following Tenover’s criteria (Fig. 1) [10]. All isolates were ST398, SCCmec-V, agr-1, and PVL genes-negative. They belonged to three spa types; t108, t011, and t1255.

The age of the three patients was 59, 82, and 83 years, respectively. Two patients owned pigs and the other a calf. Two patients were diabetic and were hospitalized because they developed skin and soft-tissue infections by MRSA ST398. The third patient had bronchitis and the strain was isolated from a respiratory secretion submitted to the laboratory from an outpatient clinic. The three patients had had multiple hospital admissions in the last 12 months.

As it has been described previously, the ST398 isolates were resistant to tetracycline [2]. Only another strain from the 44 MRSA strains studied was also resistant to tetracycline. This one belonged to the ST239 clone that was epidemic in north-west Spain until 2002, and since then, it has scarcely been isolated [3]. The ST239 clone is easily identified because of the homogeneity in the resistance profile (it is also resistant to levofloxacin, gentamicin, tobramycin, erythromycin, clindamycin, trimethoprim-sulfamethoxazole, and chloramphenicol) [3]. Therefore, it can be stated that the resistance to tetracycline could be a local marker for a presumptive identification of the ST398 clone.

Human infections caused by methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398 (ST398) have been emerging in recent years in Europe (1,2). Pigs represent a common reservoir of MRSA ST398, and working with these animals may constitute a risk factor for MRSA carriage and possible infection (2–4). We report a case of human infection caused by MRSA ST398 in Spain.

We describe the first outbreak of non-typable methicillin-resistant Staphylococcus aureus on a surgical ward in the Netherlands in June 2007. Nine cases of infection and/or colonisation were found among patients and healthcare workers.

Background

In the Netherlands, the proportion of methicillin-resistant S. aureus (MRSA) among clinical isolates of S. aureus is still low [1], but community-acquired MRSA occurs more frequently [2]. This increase is mainly caused by so called ‘non-typable’ MRSA (NTMRSA, i.e. not typable by pulsed-field gel electrophoresis (PFGE) with Sma1 restriction digest [3]) belonging to multilocus sequence typing (MLST) type ST398 [4].

These strains are widely disseminated among pigs, veal calves and people in contact with pigs [5-8]. An association between the use of antibiotics in pig farming and the dissemination of these strains has been suggested [6,8], since the majority of ST398 MRSA are tetracycline-resistant and oxytetracyclins are the most frequently used antibiotics in pig farming.

Transmission within families, as well as single cases of colonised healthcare workers, have been described [5]. One report indicates possible healthcare-acquired infections with a Panton-Valentine leukocidin (PVL)- positive ST398 strain in China [9], but no nosocomial transmission to multiple patients or healthcare workers has occurred in the Netherlands to date.

Outbreak description

In June 2007, MRSA was cultured from a diabetic foot ulcer of a patient on a surgical ward. Subsequent screening of contacts among patients and healthcare workers revealed four additional patients with MRSA infection and/or colonisation and five healthcare workers who carried MRSA.

Two of the five affected patients (one with prostate carcinoma and one with a diabetic foot) were successfully decolonised with mupirocin nasal ointment, chlorhexidine wash, and treatment with trimetoprim/rifampicin.

A further colonised patient with a gastro-intestinal malignancy and two patients with infected diabetic foot ulcers remained colonised, despite several decolonisation regimens.

Of 238 healthcare workers who were screened, five were colonised in the nose and/or throat and had no skin conditions. All five have been treated with mupirocin nasal ointment and chlorhexidine wash and successfully decolonised.

All strains were resistant to tetracycline and non-typable by PFGE. Spa-typing showed that all strains were spa-type t567. This spa-type corresponds to MLST type 398, a type previously found in pigs.

None of the patients had had contact with pigs or veal calves. One healthcare worker lived on the grounds of a pig farm but neither she nor her partner came into contact with pigs themselves. While we presume that this health care worker was the source of the infection, this could not be proven. Permission to sample the pigs on this farm was not granted.

Conclusions

The NT-MRSA strain responsible for this outbreak was spa-type t567, which corresponds to MLST type ST398, the clonal complex to which most of NT-MRSA strains belong. This outbreak shows that transmission on a larger scale than a one-on-one transmission between caretaker and patient can occur with NT-MRSA in a hospital setting.

Screening of pig farmers and pigs in The Netherlands has revealed that >20% of pig farmers and 39% of slaughterhouse pigs are positive for an unusual strain of methicillin-resistant Staphylococcus aureus (MRSA) belonging to sequence type (ST) 398. It is now clear that the emergence of ST398 is not just a Dutch problem, with human infections being described in several European countries, Canada and Singapore. Furthermore, some human isolates have now acquired the genes encoding Panton–Valentine leukocidin. Livestock may become an important source of community-acquired MRSA. A concerted effort on the part of clinicians, infection control practitioners and veterinarians will be required to prevent further spread of this novel strain of MRSA.

To the Editor: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been identified in livestock animals (particularly pigs), veterinarians, and animal farm workers (1,2). CA-MRSA strains from pigs have been classified most frequently within the multilocus sequence type (ST) 398 (1) and have been rarely identified as a cause of invasive infection in humans (1,3,4). We report a case of invasive infection in a pig-farm worker in Cremona, Italy, an intensive animal farming area; the infection was caused by MRSA of swine origin, ST398.

To the Editor: It has recently become apparent that livestock can constitute a new methicillin-resistant Staphylococcus aureus (MRSA) reservoir and be a source of a novel and rapidly emerging type of MRSA. These livestock-associated MRSA clones are nontypeable by use of pulsed-field gel electrophoresis with SmaI and belong to sequence type (ST) 398 (1). MRSA ST398 clones account for 20% of all MRSA in the Netherlands (2), but the emergence of such clones has been described worldwide (3). Although ST398 transmission has been reported primarily between animals, persons with occupational exposure to livestock are at higher risk for MRSA carriage than the general population. Even though MRSA ST398 usually causes colonization, several cases of infections of variable clinical relevance, varying from skin and soft tissue infections (4) to endocarditis (5) and pneumonia (6), have been described over the past few years. Most instances of ST398 human carriers have been identified among persons who work at pig farms (7). Data regarding MRSA colonization of dairy farmers are less exhaustive and, to our knowledge, only 1 instance of direct transmission between cattle and humans has been proven. MRSA isolates from cows with subclinical mastitis in 2007 in Hungary were indistinguishable from MRSA isolates from the tonsil swab of a farmer who worked with these animals (. We report a case of MRSA ST398 invasive disease in a cattle farmer, as well as a case of MRSA ST398 necrotizing fasciitis

Conclusions Human carriage of MRSA was associated with swine colonization with MRSA. Prevalence rate (38%) was higher than that for hospitalized patients or nursing home residents in Belgium (www.nsih.be/surv_mrsa/download_fr.asp). MRSA isolates from farmers belonged to closely related spa types corresponding to ST398, which are unrelated to hospital- and community-acquired strains but identical to strains from humans in contact with pigs in other European countries (1,2,10).

Received 28 October 2009; revised 24 December 2009; accepted 28 December 2009. Available online 11 January 2010.

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is infrequently reported in mastitis. Yet, as in many other countries, the prevalence of methicillin resistance among S. aureus from mastitis is currently unknown in Belgium.

To elucidate this, the presence of mecA was investigated in 118 S. aureus strains originating from diagnostic mastitis milk samples from 118 different farms experiencing S. aureus mastitis. MRSA strains were characterized by disk diffusion susceptibility testing, spa-typing, MLST and SCCmec-typing. In an additional study, four MRSA-positive farms were selected to assess the in-herd prevalence of MRSA, by sampling all cows in lactation. Isolated MRSA strains were similarly characterized.

The mecA gene was detected in 11 (9.3%) of the 118 S. aureus isolates, indicating that nearly 10% of the Belgian farms suffering from S. aureus mastitis have an MRSA problem. The in-herd prevalence varied between 0% and 7.4%. Characterization of the MRSA strains showed that they were all resistant to tetracycline. Additional resistances to macrolides, lincosamides and aminoglycosides were frequently detected. The strains were ST398, spa-types t011 or t567 and had SCCmec-type IVa or V, proving that they belong to the emerging livestock-associated MRSA (LA-MRSA) strains of CC398.

Our study shows that after detection in Belgian pigs, horses and poultry, LA-MRSA has also attained Belgian cattle. It is the first report on frequent isolation of LA-MRSA from bovine infections. As the in-herd isolation rate resembles that of regular S. aureus in farms experiencing S. aureus mastitis, the multi-resistance of LA-MRSA strains may cause future treatment problems.

Received 30 March 2008; revised 23 June 2008; accepted 26 June 2008. Available online 5 July 2008.

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) infections do occur in equine patients. Little is known, however, about their origin and the general equine MRSA colonization status. In West European horses in particular, neither the colonization rate nor the present strains or their antimicrobial susceptibility patterns are known.

In the present study, a sample of 110 (Belgian, French, Dutch and Luxemburg) horses presented at a Belgian equine clinic was screened for nasal MRSA carriage. An indirect culturing protocol using a 0.001% colistin and nalidixic acid containing broth was compared to a direct agar method. Phenotypic identification following growth on a chromogenic MRSA screening agar (ChromID™ MRSA) was combined with genotypic analysis (PCR, PFGE, SCCmec, spa, and MLST typing). Antimicrobial susceptibility was tested through disk diffusion.

Twelve (10.9%) horses carried MRSA, with the enrichment protocol resulting in a significantly higher isolation rate. None of the isolated strains were typeable through SmaI PFGE. They all harboured SCCmec type IVa or V and belonged to spa type t011 or t1451 of the ST398 lineage. All isolates were tetracycline resistant and sulfonamide and enrofloxacin susceptible. Macrolide, lincosamide, trimethoprim and aminoglycoside susceptibility varied and in total five different antimicrobial resistance patterns were distinguished.

These results show that ST398 is certainly present in West European horses. Due to its known interspecies transmission and the structure of the equine industry, the presence of this clone in horses poses a substantial health hazard for both animals and humans.

Received 29 May 2009; revised 9 July 2009; accepted 3 August 2009. Available online 8 August 2009.

Abstract

At the Veterinary Microbiological Diagnostic Center, the Netherlands, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) isolates found in equine clinical samples increased from 0% in 2002 to 37% in 2008. MRSA of spa-type t064, belonging to MLST ST8 and spa-types t011 and t2123, both belonging to the livestock-associated MLST ST398, predominated.

During an outbreak of post-surgical MRSA infections in horses at a veterinary teaching hospital in 2006/2007, MRSA isolates of spa-type t2123 were cultured from 7 horses and 4/61 personnel which indicated zoonotic transmission. After intervention the outbreak stopped. However, another outbreak occurred in 2008, where 17 equine MRSA isolates of spa-type t011 (n = 12), t2123 (n = 4), and t064 (n = 1) were found. This time, 16/170 personnel were positive for MRSA with spa-type t011 (n = 11) and t2123 (n = 5). Personnel in close contact with horses were more often MRSA-positive (15/106) than those without (1/64).

Screening of horses upon admission showed that 9.3% were MRSA-positive predominantly with spa-type t011. Weekly cross-sectional sampling of all hospitalized horses for 5 weeks showed that 42% of the horses were MRSA-positive at least once, again predominantly with spa-type t011, which suggests that nosocomial transmission took place. Fifty-three percent of the environmental samples were MRSA-positive, including samples from students’ and staff members’ rooms, and all were spa-type t011. This indicates that humans contribute to spreading the organism. Culturing of samples employing high-salt pre-enrichment performed better than a comparable method without pre-enrichment.

Our results show that nosocomial transmission occurs in equine clinics and suggests that personnel play a role in the transmission.

aCentre for Infectious Disease Control Nertherlands, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

Received 20 March 2009; revised 8 May 2009; accepted 8 May 2009. Available online 11 June 2009.

Abstract

In The Netherlands, MRSA ST398 has emerged in hospitals and human carriers have been associated with exposure to pigs and cattle. High prevalences of MRSA ST398 in pigs and pig farmers have been determined and the transmission routes of MRSA on pig farms need to be elucidated. In the south of the Netherlands, in recent years, the black rat (Rattus rattus) has emerged as a prominent rodent on livestock farms. From March till May 2008, a survey on MRSA in rats living on livestock farms in the south of The Netherlands and the north of Belgium was conducted. In total, 40 black rats (R. rattus) and 3 brown rats (Rattus norvegicus) were collected on 12 farms including five pig farms, five poultry farms, one mixed pig and veal farm and one goat farm. MRSA ST398 was detected in black rats captured at two of the five pig farms as well as in a black rat living on the mixed pig and veal farm. From one black rat captured at another pig farm MRSA ST 97 was isolated. Considering the behaviour of rats on livestock farms, it is concluded that rats might play a role in the spread and persistence of MRSA on pig farms.

Sir, Methicillin-resistant Staphylococcus aureus (MRSA) strains belonging to clonal lineage sequence type (ST) 398 are being reported at an increasing frequency in Europe.1 This new MRSA type has been isolated from colonized and infected animals and humans, and also from meat in some countries,1,2 representing a risk to human health; nevertheless, so far, no data about detection of MRSA ST398 in food in Spain have been published.

Received 13 August 2008; revised 18 November 2008; accepted 7 December 2008. Available online 13 December 2008.

Abstract

Recently the isolation of methicillin-resistant Staphylococcus aureus (MRSA) strains from several food-producing animals has been reported. During slaughtering of MRSA-positive animals, contamination of carcasses with MRSA may occur and consequently the meat of these animals may get contaminated. The aim of this study was to estimate the prevalence of MRSA in raw meat samples from the retail trade.

Samples of raw beef, pork, veal, lamb/mutton, chicken, turkey, fowl and game were collected from the retail trade. A detection method including a two-step enrichment in Mueller–Hinton broth + 6.5% NaCl and phenol red mannitol broth containing ceftizoxime and aztreonam, followed by isolation on MRSA ID agar (bioMérieux) was evaluated and subsequently applied for the detection of MRSA in samples of raw meats.

MRSA strains were isolated from 264 (11.9%) of 2217 samples analyzed. Isolation percentages for the meat species were: beef (10.6%), veal (15.2%), lamb and mutton (6.2%), pork (10.7%), chicken (16.0%), turkey (35.3%), fowl (3.4%) and game (2.2%). The majority (85%) of the isolated strains belonged to spa-types of pulsed-field gel electrophoresis (PFGE) non-typeable (NT)-MRSA, corresponding to the multilocus sequence type ST398, a type also recently isolated in the Netherlands from pigs. However, a smaller part of these strains were found to be of other ST's, possibly of human origin.

Further studies are needed to elucidate transmission routes of MRSA in relation to meat and other foods and to provide the tools for preventing the spread of MRSA. At present the high prevalence of MRSA in meat has not been shown to contribute significantly to the dissemination of MRSA to humans and the possible health hazard for consumers of the presence of MRSA in foods should be further elucidated.

According to one study, when different countries introduced certain antibiotics on farms, a surge occurred in people contracting antibiotic resistant intestinal infections one to two years later. One infection, Campylobacter, increased 20 percent in Denmark and 70 percent in Spain.

After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.

Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.

"It's not going to be a time bomb that goes off like this," said Dr. Frank Aarestrup, of the Danish Food Institute at the University of Denmark. "It's something that's slowly getting more and more complicated, more difficult for us to actually treat infections.